[Comparative analysis of serological tests performed in immigrants in the Lleida health area]. / Análisis comparativo de las serologías realizadas a los inmigrantes en la región sanitaria de Lleida.

OBJECTIVE: Evaluate the process of screening and detection of HIV, HBV, HCV and syphilis in the province of Lleida by determining the proportions of positive results in the different groups during one year. DESIGN: Descriptive, multicentre study of all the serological tests performed in immigrants and natives attended in 2007. SETTING: Province of Lleida (Spain). PARTICIPANTS: 255,410 users. MAIN MEASUREMENTS: Age, sex, country of origin and period of residence in Spain, and the results for HIV, hepatitis B, hepatitis C and syphilis. We calculated the proportions in which a serological test had been requested, and examined the association between the rates of positive tests and the geographical area of origin, and calculated age-adjusted rates taking the age distribution of the native population as the reference. RESULTS: Risk of HBV was 4.6 times higher in immigrants than in natives (11.7 times in sub-Saharan Africans). The rate of positive syphilis tests was three times higher in the immigrant group. For HIV the PR was 2.3 (sub-Saharan Africans 7.4). For hepatitis C the risk was lower in immigrants than in natives (PR=0.4). CONCLUSIONS: Immigrants have a higher probability of testing positive in screening in hepatitis B, syphilis and HIV. The rates differ significantly according to the origin of the immigrant.

[Poorer diabetes control among the immigrant population than among the autochthonous population]. / La población inmigrante controla peor su diabetes que la población autóctona.

INTRODUCTION: Ethnic differences are known to exist in the prevalence of diabetes, but little is known about possible differences in the degree of diabetes control among ethnic groups. The aim of this study was to determine whether there are differences in diabetes detection and control between immigrants and the autochthonous population in our health region. METHODS: We performed a cross-sectional, observational, population-based study of all patients diagnosed with diabetes mellitus type 2 registered and treated in 2010. We analyzed diabetes quality indicators and used multivariate logistic regression models adjusted for age, sex and number of visits. The adjustment method was forced and the absence of collinearity was identified through the ROC curve and Hosmer and Lemeshow's test. RESULTS: There were 77,999 autochthonous patients (6,846 diabetics) and 30,748 immigrant patients (415 diabetics). A total of 8.78% of the autochthonous patients were diabetic versus 1.35% of immigrants (p <0.001). HbA1c <7.5% was found in 68.04% of the native population compared with 54.76% of immigrants. The probability of achieving optimal HbA1c control was 27% lower in immigrants (adjusted OR=0.73), while the probability of achieving good HbA1c control was 30% lower in the immigrant cohort. The model showed moderate discrimination (ROC =0.65 and Hosmer and Lemeshow's contrast, p>0.05). CONCLUSIONS: Diabetes control and quality indicators are poorer in some immigrant groups.

La población inmigrante controla peor su diabetes que la población autóctona / Poorer diabetes control among the immigrant population than among the autochthonous population

Introducción: Se sabe que hay diferencias entre los grupos de inmigrantes en lo que respecta a la prevalencia de diabetes, pero no disponemos de suficiente evidencia para afirmar que, una vez diagnosticada,sea distinto el grado de control. El objetivo de este estudio es analizar si hay diferencias en la detección y elgrado de control de los pacientes diabéticos entre inmigrantes y autóctonos en nuestra región sanitaria.Método: Estudio poblacional observacional transversal que incluye a todos los pacientes diagnosticadosde diabetes mellitus de tipo 2 asignados y atendidos durante 2010. Se analizaron los indicadores decalidad de la diabetes y se utilizaron modelos de regresión logística multivariada que se ajustaron por laedad, el sexo y el número de visitas. El método de ajuste fue forzado y se comprobó la no presencia decolinealidad mediante la curva ROC y el test de Hosmer & Lemeshow.Resultados: 77.999 pacientes autóctonos (6846 diabéticos) y 30.748 pacientes inmigrantes (415 diabéticos). El 8,78% de los pacientes autóctonos eran diabéticos (1,35% de los inmigrantes, p <0,001). La HbA1c<7,5% era del 68,04% en la población autóctona y del 54,76% en los inmigrantes. Los inmigrantes tienen un riesgo un 27% inferior de alcanzar el control óptimo de HbA1c (OR ajustada = 0,73). El riesgo detener un buen control de HbA1c fue un 30% inferior en el grupo inmigrante. El modelo discriminabamoderadamente (ROC = 0,65 y contraste de Hosmer & Lemeshow; p >0,05).Conclusiones: Hay un peor control y un peor registro de los indicadores de calidad en la atención de ladiabetes mellitus en algunos grupos de inmigrantes (AU)

Introduction: Ethnic differences are known to exist in the prevalence of diabetes, but little is known aboutpossible differences in the degree of diabetes control among ethnic groups. The aim of this study was todetermine whether there are differences in diabetes detection and control between immigrants and theautochthonous population in our health region.Methods: We performed a cross-sectional, observational, population-based study of all patients diagnosed with diabetes mellitus type 2 registered and treated in 2010. We analyzed diabetes quality indicatorsand used multivariate logistic regression models adjusted for age, sex and number of visits. The adjustmentmethod was forced and the absence of collinearity was identified through the ROC curve and Hosmerand Lemeshow’s test.Results: There were 77,999 autochthonous patients (6,846 diabetics) and 30,748 immigrant patients (415diabetics). A total of 8.78% of the autochthonous patients were diabetic versus 1.35% of immigrants (p<0.001). HbA1c <7.5% was found in 68.04% of the native population compared with 54.76% of immigrants.The probability of achieving optimal HbA1c control was 27% lower in immigrants (adjusted OR = 0.73),while the probability of achieving good HbA1c control was 30% lower in the immigrant cohort. The modelshowed moderate discrimination (ROC =0.65 and Hosmer and Lemeshow’s contrast, p > 0.05).Conclusions: Diabetes control and quality indicators are poorer in some immigrant groups (AU)

Análisis comparativo de las serologías realizadas a los inmigrantes en la región sanitaria de Lleida / Comparative analysis of serological tests performed in immigrants in the lleida health area

Objetivo: Evaluar el proceso de cribado y detección de virus de la inmunodeficiencia humana (VIH), virus de la hepatitis B (VHB) y de la hepatitis C (VHC) y sífilis en los inmigrantes de nuestra región sanitaria, determinando las proporciones de resultados positivos entre colectivos durante un año. Diseño: Estudio descriptivo multicéntrico donde se analizaron todas las serologías realizadas a inmigrantes y autóctonos atendidos durante todo el año 2007. Emplazamiento: Provincia de Lleida (España). Participantes: Se incluyeron 255.410 usuarios. Mediciones principales: Edad, sexo, país de origen y tiempo de permanencia en nuestro país y los resultados para VIH, hepatitis B, hepatitis C y sífilis. Se evaluó si había asociación entre las tasas de marcadores positivos y la zona geográfica de procedencia. Se calcularon las tasas ajustadas por grupos de edad estandarizadas según el método directo. Resultados: El colectivo de origen inmigrante presenta 4,6 veces más probabilidades de tener VHB que el colectivo autóctono (razón de porcentajes [RP]=4,6), siendo el colectivo sudafricano y de Europa del Este el que presenta una mayor probabilidad de VHB (RP=11,7 y 4,5). En la sífilis el porcentaje de positivos es 3 veces mayor en el colectivo inmigrante con las diferencias mayores detectadas en el colectivo latinoamericano (RP=5,5). En el VIH la RP en inmigrantes fue de 2,3 (específicamente en subsaharianos una RP=7,4). En la hepatitis C los inmigrantes obtienen un menor riesgo de ser positivos que los autóctonos (RP=0,4). Conclusiones: Se constatan diferencias importantes en la probabilidad de detectar un resultado positivo de hepatitis B, sífilis o VIH en el cribado cuando el usuario es de origen inmigrante(AU)

Objective: Evaluate the process of screening and detection of HIV, HBV, HCV and syphilis in the province of Lleida by determining the proportions of positive results in the different groups during one year. Design: Descriptive, multicentre study of all the serological tests performed in immigrants and natives attended in 2007.SettingProvince of Lleida (Spain). Participants: 255,410 users. Main measurements: Age, sex, country of origin and period of residence in Spain, and the results for HIV, hepatitis B, hepatitis C and syphilis. We calculated the proportions in which a serological test had been requested, and examined the association between the rates of positive tests and the geographical area of origin, and calculated age-adjusted rates taking the age distribution of the native population as the reference. Results: Risk of HBV was 4.6 times higher in immigrants than in natives (11.7 times in sub-Saharan Africans). The rate of positive syphilis tests was three times higher in the immigrant group. For HIV the PR was 2.3 (sub-Saharan Africans 7.4). For hepatitis C the risk was lower in immigrants than in natives (PR=0.4). Conclusions: Immigrants have a higher probability of testing positive in screening in hepatitis B, syphilis and HIV. The rates differ significantly according to the origin of the immigrant(AU)